Dataset Information

Instrumented Test of Sensory Integration for Balance: A Validation Study.

ABSTRACT: BACKGROUND AND PURPOSE:Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment. Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative. This is the first study to compare the modified Clinical Test of Sensory Integration for Balance (i-mCTSIB) to the laboratory test of the Sensory Organization Test (SOT) with dynamic posturography in a group of participants with Parkinson's disease (PD) and subtle balance limitations. The purpose of this study was to (1) determine the concurrent validity of the i-mCTSIB with the SOT (6 and 4 conditions) and (2) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months. METHODS:This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson's Disease Rating Scale score of 32.7 (13.5) out of 108. RESULTS:The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated: composite scores r = -0.64 (P ? .001), C1 r = -0.43 (P = .03), C3 r = -0.60 (P ? .01), and C4 r = -0.54 (P ? .001). A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers (P = .04). In contrast, the SOT composite was not significantly different between fallers and nonfallers (P = 0.31). DISCUSSION:The results suggest that the i-mCTSIB may be a valid and clinically meaningful measure of sensory organization in persons with PD, even those with mild postural instability as measured by the median Hoehn and Yahr score (2.0). Future research should evaluate predictive validity of the i-mCTSIB for prospective falls. CONCLUSION:The instrumented mCTSIB with portable, body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT. Instrumenting mCTSIB may also distinguish between fallers and nonfallers.

SUBMITTER: Freeman L

PROVIDER: S-EPMC5441972 | biostudies-literature | 2018 Apr/Jun

REPOSITORIES: biostudies-literature

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Instrumented Test of Sensory Integration for Balance: A Validation Study.

Freeman Lynn L Gera Geetanjali G Horak Fay B FB Blackinton Mary T MT Besch Mark M King Laurie L

Journal of geriatric physical therapy (2001) 20180401 2

<h4>Background and purpose</h4>Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment. Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative. This is the first study to compare the modified Clinical Test of Sensory Integration for Balance (i-mCTSIB) to the laboratory test of the Sensory Organization Test (SOT) with dynamic posturography in a ...[more]

PMID: 27893564

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Project description:ContextTraditional assessments of reactive balance require sophisticated instrumentation to ensure objective, highly repeatable paradigms. This instrumentation is clinically impractical. The Push and Release test (P&R) is a well-validated clinical test that examines reactive balance, and the application of wearable inertial measurement units (IMU) enables sensitive and objective assessment of this clinically feasible test. The P&R relies on administrator experience and may be susceptible to interadministration reliability concerns. The purpose of this study was to evaluate the interadministrator reliability of objective outcomes from an instrumented, modified version of the P&R test.DesignCrossover interadministrator design.MethodsTwenty healthy adults (20-35 y) completed the P&R in 4 directions with 2 different administrators. Measures quantified using IMUs included step latency, step length, and time to stability. Lean angle (LA) at release was used as a measure of administration consistency. The intraclass correlation coefficient (ICC) estimate was used to assess interadministrator reliability in each direction. To determine consistency of LA within and across administrators, we calculated the SDs for each rater by direction and the interadministrator reliability of LA using ICC.ResultsAcross individual directions, the ICC for agreement between raters ranged from .16 to .39 for step latency, from .52 to .62 for time to stability, and from .48 to .84 for step length. Summary metrics across all 4 directions produced higher ICC values. There was poor to moderate consistency in administration based on LA, but LA did not significantly affect any of the outcomes.ConclusionThe modified P&R yields moderate interadministrator reliability and high validity. Summary metrics over all 4 directions (the maximum step latency, the median time to stability, and the median step length) are likely more reliable than direction-specific scores. Variations in body size should also be considered when comparing populations.

Project description:A perturbed postural balance test can be used to investigate balance control under mechanical disturbances. The test is typically performed using purpose-built movable force plates. As instrumented treadmills become increasingly common in biomechanics laboratories and in clinical settings, these devices could be potentially used to assess and train balance control. The purpose of the study was to investigate how an instrumented treadmill applies to perturbed postural balance test. This was investigated by assessing the precision and reliability of the treadmill belt movement and the test-retest reliability of perturbed postural balance test over 5 days. Postural balance variables were calculated from the center of pressure trajectory and included peak displacement, time to peak displacement, and recovery displacement. Additionally, the study investigated short-term learning effects over the 5 days. Eight healthy participants (aged 24-43 years) were assessed for 5 consecutive days with four different perturbation protocols. Center of pressure (COP) data were collected using the force plates of the treadmill while participant and belt movements were measured with an optical motion capture system. The results show that the treadmill can reliably deliver the intended perturbations with <1% deviation in total displacement and with minimal variability between days and participants (typical errors 0.06-2.71%). However, the treadmill was not able to reach the programmed 4 m/s2 acceleration, reaching only about 75% of it. Test-retest reliability of the selected postural balance variables ranged from poor to good (ICC 0.156-0.752) with typical errors between 4.3 and 28.2%. Learning effects were detected based on linear or quadratic trends (p < 0.05) in peak displacement of the slow forward and fast backward protocols and in time to peak displacement in slow and fast backward protocols. The participants altered the initial location of the COP relative to the foot depending on the direction of the perturbation. In conclusion, the precision and accuracy of belt movement were found to be excellent. Test-retest reliability of the balance test utilizing an instrumented treadmill ranged from poor to good which is, in line with previous investigations using purpose-built devices for perturbed postural balance assessment.

Project description:Balance during stance is regulated by active control mechanisms that continuously estimate body motion, via a "sensory integration" mechanism, and generate corrective actions, via a "sensory-to-motor transformation" mechanism. The balance control system can be modeled as a closed-loop feedback control system for which appropriate system identification methods are available to separately quantify the sensory integration and sensory-to-motor components of the system. A detailed, functionally meaningful characterization of balance control mechanisms has potential to improve clinical assessment and to provide useful tools for answering clinical research questions. However, many researchers and clinicians do not have the background to develop systems and methods appropriate for performing identification of balance control mechanisms. The purpose of this report is to provide detailed information on how to perform what we refer to as "central sensorimotor integration" (CSMI) tests on a commercially available balance test device (SMART EquiTest CRS, Natus Medical Inc, Seattle WA) and then to appropriately analyze and interpret results obtained from these tests. We describe methods to (1) generate pseudorandom stimuli that apply cyclically-repeated rotations of the stance surface and/or visual surround (2) measure and calibrate center-of-mass (CoM) body sway, (3) calculate frequency response functions (FRFs) that quantify the dynamic characteristics of stimulus-evoked CoM sway, (4) estimate balance control parameters that quantify sensory integration by measuring the relative contribution of different sensory systems to balance control (i.e., sensory weights), and (5) estimate balance control parameters that quantify sensory-to-motor transformation properties (i.e., feedback time delay and neural controller stiffness and damping parameters). Additionally, we present CSMI test results from 40 subjects (age range 21-59 years) with normal sensory function, 2 subjects with results illustrating deviations from normal balance function, and we summarize results from previous studies in subjects with vestibular deficits. A bootstrap analysis was used to characterize confidence limits on parameters from CSMI tests and to determine how test duration affected the confidence with which parameters can be measured. Finally, example results are presented that illustrate how various sensory and central balance deficits are revealed by CSMI testing.

Dataset Information

Instrumented Test of Sensory Integration for Balance: A Validation Study.

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Instrumented Test of Sensory Integration for Balance: A Validation Study.

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